Tracheostomy Suctioning

Tracheostomy suctioning
TRACHEOSTOMY SUCTIONING
PHYSICIAN TO SPECIFY: - Check Appropriate Boxes:
Same catheter per
Sterile catheter each
school day [ ] time [ ]
Bulb Syringe[ ] Inner cannula care [ ]
Required
I. PERSONNEL
A. School Nurse
B. Designated school personnel under direct or indirect supervision by the school
nurse.
II. GENERAL INFORMATION
A. Tracheal suctioning is performed to maintain an open airway by keeping it clear
of excessive secretions and to stimulate cough.
B. A qualified person, trained in trach suctioning, must be immediately present &
accompany the student at all times; including transportation and field trips.
C. The student must have easy access to the suctioning equipment at all times.
D. The student should be encouraged to clear airway by coughing and possibly
eliminate the need for suctioning.
E. Unnecessary suctioning should be avoided to reduce chances of tracheal injury
and infection. Increased suctioning may lead to tracheal irritations and/or
increased secretions.
F. Suctioning shall be performed:
1. According to physician’s orders which may include removal of inner cannula.
2. Upon request of child.
3. When noisy, moist respirations occur.
4. When respiratory distress exists (restlessness, crying, anxious look, pale or
dusky color, chest retractions, nasal flaring and/ or labored breathing).
5. When mucous is visible at trachea opening and student is unable to clear it
with cough.
Revised 4/2006- AAP approval pending
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Tracheostomy suctioning
III.
TRACHEOSTOMY SUCTIONING
Student’s Name:_________________________________ DOB:___________________
Equipment
and Supplies
*(Responsibility
of parent/care
provider)
1. *Suction machine including
collecting bottle, connecting tube
and adapter when needed.
2. *Resuscitation bag when ordered
(such as Ambu bag).
3. *Sterile disposable suction
catheters and/or bulb syringe if
indicated.
4. *Extra sterile tracheostomy
replacement kit.
5. *Non-waxed clean paper cups.
ESSENTIAL STEPS
PROCEDURE
1. Verify that the tracheostomy tube is in
place and secure.
2. Verify at the beginning of each school day
that all equipment/supplies are ready for
immediate use and document on the
checklist.
3. Turn suction machine on and place thumb
over end of connecting tubing (ensure that
connecting tube is in place).
a. Assure that suction bottle is clean and
empty.
4. Determine need for suction.
5. Explain procedure to the child at
appropriate level of understanding.
6. *Supply of sterile normal saline (or
single dose vials).
7. *Supply of water.
8. *Sterile syringes for introducing saline
into trachea.
9. Clean tissues or gauze pads.
10. Plastic lined wastebasket (kept beside
machine and used for contaminated
materials).
11. Personal protective equipment (face
& eye protection, apron, gloves, etc.)
KEY POINTS & PRECAUTIONS
Bus aide must verify prior to transporting student
to school.
For bus transportation: if equipment is not
functioning, then student will not be permitted to
attend school.
Note: For machines with adjustable manometers
ensure that pressures are appropriate as follows:
Infant (less than 2 years): 50-95 mm Hg
Child (2-8 years): 95-100mm Hg
Adult (8 & above): greater than 115 mm Hg
Revised 4/2006- AAP approval pending
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Tracheostomy suctioning
ESSENTIAL STEPS
KEY POINTS & PRECAUTIONS
6. Position student. Positioning is dependent upon student’s condition a
physician’s recommendations. Consider
positioning student in a location that can easily
be disinfected.
7. Wash hands.
8. Assemble and prepare equipment on a Clean field can be established by using a clean
clean field
covering (disposable towel, paper towel,
a. Fill paper cup with water.
waterproof pad, etc.) over any cart, tabletop,
b. Open catheter package and while countertop, wheelchair tray, stool, etc.
leaving catheter in its wrapper, attach Catheter is left in wrapper to prevent
connecting end to suction tubing and contamination.
turn suction machine on.
May use bulb syringe if indicated (refer to Bulb
c. Open saline vial.
Syringe in Oral Nasal Suctioning).
d. Place tissues nearby.
If inner cannula is used, leave in place unless
directed otherwise by physician. If removed,
refer to Care and Cleaning of Inner Cannula.
9. Glove. Gloves are used to keep catheter and hands clean.
10. Place catheter tip in cup of water and This ensures that adequate suction is present.
suction a small amount of water through it.
11. Suction as follows:
a. Leaving the vent open, introduce the
catheter into the trach tube a distance
no longer than that tube.
b. Place thumb over vent to apply suction.
With other hand, gently rotate catheter
between thumb and forefinger while
slowly withdrawing catheter.
c. Suction no longer than 10 seconds at a
time. Allow adequate recovery time
before re-introducing catheter.
d. Repeat suctioning as needed.
ESSENTIAL STEPS
The distance for catheter insertion should be
determined during initial training of staff.
Length of trach tube can be approximated by
measuring replacement trach tube.
Suctioning past the trach tube may cause coughing,
tracheal irritation, and/or blood-tinged
secretions.
If student begins to cough, withdraw catheter while
suctioning.
IMPORTANT: If you are unable to pass catheter
through trach tube, it may be obstructed. If signs
of respiratory distress occur (labored breathing,
apnea, pallor and/or cyanosis), the trach tube
should be changed. Refer to
TRACHEOSTOMY REPLACEMENT
PROCEDURE.
Prolonged suctioning can cause throat spasm, loss
of oxygen and changes in heartbeat.
If secretions are thick, instill 3 to 5 drops of saline
into trach tube opening then repeat suctioning.
Saline aids in loosening mucous. This will cause
coughing, therefore, hold tissue near trachea to
catch spray and/or mucous to prevent
contamination of surroundings.
Respirations should be quiet and effortless at end of
suctioning.
KEY POINTS & PRECAUTIONS
Revised 4/2006- AAP approval pending
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Tracheostomy suctioning
12. Suction sufficient water through catheter
to clear out tubing.
13. If catheter can be used again (per
physician order), replace catheter in
package.
14. If catheter cannot be used again, hold
catheter in gloved hand, pull glove off,
encase catheter in glove and discard both.
15. Discard paper cup.
16. Wash hands.
17. Recap water and make sure equipment is
ready for immediate reuse.
18. At the end of the school day, glove and
empty contents of suction bottle into
toilet and rinse with water.
19. Close plastic liner of wastebasket
securely prior to disposal.
20. Record procedure on SPHCS log.
Cleaning and disinfecting the suction
canister is a parent/careprovider responsibility.
However, if the suction machine is school property
and remains at school then it must be cleaned
according to manufacturer’s instructions.
Revised 4/2006- AAP approval pending
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